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Planning around staff shortages in radiology might seem like a future inevitability for departmental directors, British researchers wrote in a Radiographystudy published this month. But employees’ greatest source of psychological stress doesn’t stem from a lack of colleagues—it comes from the uncertainty of a constantly shifting job market.

Paul K. Miller, PhD, of the department of medical and sport sciences at the University of Cumbria in Lancaster, England, and a team of his colleagues said in Radiography ultrasound clinics in their country have been understaffed for “some time,” leading the government to declare sonography a “shortage specialty” by 2013.

It’s not uncommon for imaging departments to be short of qualified candidates, Miller et al. wrote—as evidenced by take today’s large-scale radiology crisis in Scotland. But most research surrounding those shortages has been broad and focused on numbers and migration patterns of employees, ignoring what those statistics mean to the actual radiologists and technologists working in understaffed environments.

“While socio-structural issues are of foundational importance in understanding the broader causes and consequences of present staff shortages in U.K. ultrasound, it is also important to reflect upon the resultant personal and interpersonal consequences that can emerge for managers and staff themselves,” the authors wrote. “Indeed, the social-psychological impacts of understaffing have been historically under-researched across a range of organizational contexts, not least those in healthcare.”

Radiology shortages have been linked to increased levels of stress among physicians, physiological deterioration and more staff injuries, they said. Patient care has also been affected, with some studies reporting more postoperative complications, higher mortality rates and greater healthcare-associated infections with underqualified staff.

Understaffing also cuts into physicians’ time to connect with patients, meaning quality care is compromised in the process. Because radiologists are so often rushing from one patient to the next, Miller and co-authors said, they have little opportunity to learn from their clinical experiences and may feel they’ve provided inadequate care to their many patients. And with so many clinicians retiring early due to burnout and too few entering the field, the constant state of flux in many departments is making it difficult to form a cohesive team.

“Consultant radiographers typically rely upon a sense of consistency, and consistently reliable feedback, from other departmental staff in generating their own sense of self-efficacy,” the authors said. “In the absence of this order of consistency, a crisis of confidence often prevails.”

Miller and his team interviewed 20 ultrasound department directors for their research, including 18 who worked in the public sphere and two working in private practices. In collecting responses, they found managers were typically concerned with one of two things: either the movement of senior technologists and early retirement of staff or how staffing instabilities could undermine their clinicians’ confidence on a day-to-day basis.

One respondent said they saw colleagues on the verge of tears when a senior ultrasound technologist announced her early retirement—“so many of them relied on her for guidance”—while another worried younger staff would realize how tough technologists’ jobs were and drop out altogether.

Someone wrote they worried for the future because they had a lot of technologists they felt could leave “at their whim and it not be the end of the world for them.” Another said all department heads are worrying they’re losing techs without the promise of replacements.

“They all want to think their mates will be there for coffee forever,” one manager wrote. “But they know they might leave [for somewhere else] at any time, because the job here now is, well, it’s killing them.”

Miller and colleagues said the responses indicated managers were actually more disadvantaged by a migratory economy than short-staffing itself. They said research going forward should push past the idea that there simply “are not enough sonographers.”

“It is personnel flux, rather than simple short-staffing, that is reported to cause the greatest social-psychological problems for both managers and sonographers,” they wrote. “The issues raised herein require further examination from the perspective of sonographers themselves in order to corroborate the views of the managers interviewed.”

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